In Prince's Age Group Risk of Opioid Overdose Climbs at Middle Age

This is related to the previous post about the increasing number people dying in middle age due to toxic poisoning.  Evidence is mounting that Prince may have died of a drug overdose. While the medical examiner hasn't yet released the results of the autopsy and toxicology scans in this case, opioid overdose in middle age is all too common.

In 2013 and 2014, according to the The Centers for Disease Control and Prevention, people ages 45 to 64 accounted for about half of all deaths from drug overdose. Prince died on April 21 at his home and music studio, Paisley Park, in Minneapolis. He was 57.

There are a number of scenarios that explain the increase risk of overdose, which is often accidental, for people over 55.

Imagine you're in your 50s. You injured your shoulder a while back and it just hasn't gotten better. You take prescription painkillers — an opioid like OxyContin — to help with the pain. Let's say you've been taking it for a couple of years. Your body has built up a tolerance to the drug, and now, you need to change it up to get the same amount of relief.

When it comes to the potential for overdose, says Boston Medical Center epidemiologist Traci Green, this is one of the most dangerous crossroads.  "We oftentimes see that the dose will increase with an individual over time or they might rotate or switch to another medication to experience pain relief. And so, at each rotation or change, there's a risk [of accidental overdose] because you're moving from one drug to another," she says.

Read more about the why this age group is more susceptible to overdose:  http://www.npr.org/sections/health-shots/2016/05/05/476902228/risk-of-opioid-overdose-climbs-at-middle-age

Ethical Issues in Healthcare

On April 21, we discussed genetic testing and efforts to personalize medicine by knowing DNA and personal details about your health over time.   In addition to these topics, what other ethical quandries are there to consider?  I provide some links below, but you are welcome to post about events in the news and on documentaries.  These are just ways to get you started.   When it comes to healthcare, nothing is simple.  Consider the moral and ethical issues related to it.

There are many good resources on our blogroll and here:

• Propublica.org
• Center for Public Integrity (http://www.publicintegrity.org/health/) 
• NYTimes/Health (http://www.nytimes.com/pages/health/index.html) 
• NPR/Health (http://www.npr.org/sections/health/) 
• Center for Investigative Reporting (now called Reveal @ http://www.revealnews.org/topic/healthcare/) 
• Recent Frontline special on "Supplements and Safety":
• The booming 30-billion-dollar-plus vitamins and supplements industry says these products can make consumers healthier — but a new FRONTLINE investigation with The New York Times and the Canadian Broadcasting Corporation raises troubling questions.  Supplements and Safety investigates the hidden dangers of vitamins and supplements — exploring how they’re marketed and regulated, and how it’s often hard to know what’s really in the bottles you buy.

In the blog, provide a link to the article/video and summarize the main points.  Offer any recommendations mentioned  in the article, or your own personal opinion about what should be done to address the topic.

How Doctors Helped Drive the Addiction Crisis

We covered this topic in "Escape Fire" and we read about alternatives to treating pain with acupuncture.  Last semester I read this opinion from the Sunday NYT paper on 11/8 and decided to blog about it (than post it on FB).   It is also related to the topic we just covered. The article begins by asking, why is there an "alarming and steady increase in the mortality rate of middle-aged white Americans" since 1999? According to a study published last week (short pdf; read it), much of the excess death is attributable to suicide and drug and alcohol poisonings. Opioid painkillers like OxyContin prescribed by physicians contribute significantly to these drug overdoses. Here are two figures from the study that speak to the issue (click for a larger image):

 "Driving this opioid epidemic, in large part, is a disturbing change in the attitude within the medical profession about the use of these drugs to treat pain." The article states that the rate of death from prescription opioids in the United States dwarfed the combined mortality from heroin and cocaine, and an increasing use of . At the time this was shocking news.  Now the link to opioids to heroin What surprised you? Any remedies? Read the links and comments by others for some further thoughts. Read it here...

Few Americans Follow 4 Main Pillars of Heart Health

Most Americans know that a heart-healthy lifestyle includes eating a healthful diet, not smoking, being physically active and keeping weight and body fat down. But a new study found that fewer than 3 percent of American adults could claim all four healthy elements.

The study, published in Mayo Clinic Proceedings, was based on data gathered from the National Health and Nutrition Examination Survey from 2003 to 2006 and included a nationally representative sample of 4,745 Americans.

Do you think these finding would still be the same percentage today?  Why or why not?

You can read the short article and many comments, published on 3/24/16 in the NYTimes.

The AI Doctor Will Hear You Now

There are so many articles now on AI in medicine, it's no longer about just about IBM Watson.  Here's an article in MIT Tech Review from 3/9/16.  After all, some diagnoses are better down with an algorithm than with the human mind.  For example, there are about 10,000 known human diseases, yet human doctors are only able to recall a fraction of them at any given moment. As many as 40,500 patients die annually in an ICU in the U.S. as a result of misdiagnosis, according to a 2012 Johns Hopkins study. British entrepreneur Ali Parsa believes that artificial intelligence can help doctors avoid these mistakes.

Read the article... Can you find other examples of AI in Medicine (besides Watson, of course)?

Parsa is the founder and CEO of Babylon, a U.K.-based subscription health service that plans to launch an AI-based app designed to improve doctors’ hit rate. Users will report the symptoms of their illness to the app, which will check them against a database of diseases using speech recognition. After taking into account the patient’s history and circumstances, Babylon will offer an appropriate course of action. Currently in beta testing, the app is expected to be available later this year.

Cleveland Clinic and Patients First!

You have a week or so to post and reply to comments about Healthcare's Service Fanatics and the newer HBS Case: Cleveland Clinic: Growth Strategy 2104 (pdf of the cases). Due by Thursday, Mar. 3.  We will discuss this in class  

Synopsis: From the HBR article and the Case Study, the CEO at the Cleveland Clinic, Dr. Delos "Toby" Cosgrove’s central message to employees had been Patients First!, which demanded relentless focus on measurable quality.

“This included constant attention to patient safety, respect for the patient’s dignity, excellence in housekeeping services and facilities, and genuine concern for the patient’s emotional wellbeing and care experience.”

Dr. James Merlino became Chief Experience Officer in 2009. Merlino defined the patient experience as "everyone and everything people encountered from the time they decided to go to the Clinic until they were discharged.” He worked to make patient experience insights more tangible by asking the question: “How can processes and metrics drive improvements in the patient experience.” As you read the case, consider the following: (You can write it as a paragraph and include any issues that stood out for you as you read the case. These questions are mostly to serve as prompts for your thinking.)

1. What is the Cleveland Clinic’s overall strategy for improving value for patients?
2. Are there examples of what Cleveland Clinic are doing well, or areas where they may still need improvement?
3. What do you think of other efforts linked in the class schedule, or examples of your own, that make you feel like there is a “patient first” transformation in place or are you skeptical? Explain.

Health IT Usage Behavior and Patient Safety

I recently read a report that offered a theoretical model of health it usage behavior and implications for patient safety.   The authors chose to focus on theories that could explain clinician HIT usage behavior because of the widely observed underuse and misuse of HIT and the associated patient safety consequences.  They claim it is important to understand that poor system design, through its effect on behavior, is the root of the problem.  That is, poorly designed systems facilitate or even encourage behaviors that may be contrary to expectations, policies or goals, and the models presented here make clear that the exogenous variables are system design factors.

Perhaps the most obvious case of a HIT whose efficacy suffers from underuse is that of medical error/incident reporting systems: up to 96% of medical errors are estimated to go unreported. Briefly, reporting systems are paper-based or electronic systems used by health care providers to report in some detail the occurrence of safety-related events. These events, depending on the system, may be instances of patient harm, near-misses, preventable errors that lead to harm, detected hazards that may lead to future harm, or combinations of these. Although reporting can have various purposes, the two main ones are learning and system improvement. As an example, consider a health care organizations that foster a culture of blame and shame, not only are needs not being met, but reporting may threaten vital needs. This is illustrated in Figure 1 below, where primary needs on the hierarchy are jeopardized when one reports in a blame culture. Examining Figure 1 provides a motivational explanation as to why many studies find that fear of punitive consequences deters many clinicians from reporting, whereas ethical obligations, small rewards, and a positive reporting culture tend to be motivators.

Figure 1. Needs met and jeopardized by the reporting of medical errors in a blame culture 

Here is a video that explains what happens when cultures move from blame to identifying root causes of the problem.

When the Hospital Fires the Bullet

Here is an amazing account by Elisabeth Rosenthal and covered last week on the radio show, This American Life.  Here is a synopsis and links to the article and radio show:

A student I know at the Icahn School of Medicine got in touch to say that a young man with bipolar disorder had been shot in a Houston hospital room by off-duty police officers moonlighting on the security staff. I was skeptical.

I’m a full-time journalist now, but I am also an M.D. Twenty years ago, as a physician, I worked in a very busy New York City emergency room. I’d treated patients with mental illness, patients who were high on drugs or delusional from illness, but I’d never seen weapons of any kind. Tasers and guns in a hospital room?!

...But the tip about the patient shot in Houston was not just hearsay or rumor: The student who tipped me off was a classmate of Christian Pean, the older brother of the young man who’d been shot in Texas with both a gun and a Taser. I got some contacts for the Pean family and began a sixth-month reporting odyssey. That resulted in a New York Times article about Alan’s shooting and a companion radio piece and podcast produced by “This American Life.”

Can a Computer Replace your Doctor??

Can a Computer Replace your Doctor?

Link: http://www.nytimes.com/2014/09/21/sunday-review/high-tech-health-care-useful-to-a-point.html

As, the title suggests this article is can or will a computer (ever) replace a doctor? Has the Artificial Intelligence research and in general Computer Science algorithms developed to an extent, that a doctor with a minimum of 8 - 10 years of medical school education be replaced? The article focuses on this question from two aspects. One is the aspect from Silicon Valley and the other is from a doctor's point of view.

Silicon Valley has transformed several fields of life and is now onto transforming medicine to a point where an AI algorithm could potentially replace your doctor. The spearheads of Silicon Valley agree that they would trust and rather use a computer algorithm/robot over a doctor. Innovation of healthcare products are in such a fast pace that people might even believe it might be true. From the technologist perspective it seems to be in the right direction and since they also look into their revenue, healthcare devices seem to be giving a pretty good revenue model.

However, when this question is addressed from the doctor and Elisabeth Rosenthal's point of view, you see the bigger and deeper picture. A computer algorithm or an AI robot is just a mere tool that would guide you to a diagnosis; a bridge between a patient and his symptoms. The data provided by health tracking devices is so huge that it is hard to make sense out of it by a robot; only a doctor's presence would help make "sense" out of it for a corresponding treatment. On the other hand, if the doctor's role is given to a machine it might interpret normal data as "normal", when the patient has can actually be suffering from a condition. The article particularly emphasis a patient suffering from arrhythmias could have a normal heartbeat but actually be in trauma of knowing that, normal testosterone level might lead to a condition like Low T, etc.

In conclusion, though useful technologies has helped several people at diagnosing health ailments better especially blood glucose level and getting broader knowledge on the same, it still does not replace a doctor, rather it is a tool that would assist both you and your doctor. An analogy that the article mentions that I would like to re-iterate: Apple Maps had severe hidden bugs and lead people to "nowhere", clearly hinting it was a tool for them to use and not trust! If only they had asked someone?

Pay Till It Hurts Case

The overview of the cases is available on the side link: Case: Paying Till It Hurts. The purpose of this assignment is to give you all a chance to investigate in some depth the costly dilemma of our healthcare system. If our medical price structure remains the same, and there is no decrease in our close to $3 trillion bill, technology innovations will have limited effects. As we address other topics in the class, we can be reminded of these cases as examples.

Instructions:
Take a look at the cases described in the link above and post about the case you chose to do in class. I noted the ones I believe were chosen. If you missed class, then choose from those available and do the following:

1. On this blog, please create a NEW POST and provide the following information:
   - Article Title - provide a direct link (URL) to the article or multimedia site.
   - Topic Discussed 
2. Provide a brief description of the article (1-2 paragraphs)
   - What you learned from the article and links provided, reader perspectives, or other follow-up news.
   - Add comments to your article that may help to inform the rest of the class what you found particularly interesting and revealing about the case.
3. Comment on at least 2 other posts (or more).

Grading Rubric: 15 points - Post and discuss article on class blog (see #1) and provide sufficient detail to show what you learned. Extra Credit: 1-2 points - Read and comment to others’ postings with some reflection and thoughtfulness. There is no limit to the number of comments you can make, as long as they provide some new information, ask an interesting question, etc. (see #3).

The Cost Conundrum

Here are some questions to get you thinking about the readings for tomorrow.
Post your comments below.

These readings focus on the exorbitant cost of healthcare in the U.S.  When you compare our healthcare system to other nations who offer healthcare to those who need it at little cost (see Reid’s chapter on the different HC models), it is a paradox that as the most powerful, most innovative, and richest nation, when it comes to providing “the essential task of providing health care for people, the mighty USA is a fourth-rate power.”

Let's start with the general idea of the readings for this week:

Why is the cost of healthcare so high?

1. Why is our model of healthcare not able to control the costs and provide healthcare to those who need it?
2. Why doesn’t better technology help to reduce the costs of healthcare, or rather, why do high-tech advances increase costs instead of lowering them?

Brill says that to fix the high cost problem, we need to “let the foxes run the henhouse.”  What does he mean by that?  Do you agree?

In her NY Times series on the costs of health care, Elisabeth Rosenthal examines the price of medical care in the United States, interviewing patients, physicians, economists, and hospital and industry officials. In each installment, readers were invited to share their perspectives on managing costs and treatment. There are also follow-up articles that are related to the topic.
Assignment 2: Paying Till It Hurts (Due: on our class blog by Thurs., Feb. 4)

Video: Steven Brill on Rising Medical Costs, based on his Time magazine special issue, “The Bitter Pill”, March 4, 2013.

Video: “Bending the Cost Curve": Dr. Jeffrey Brenner

Blog Proposal

As mentioned on our class website under Homework Assignment, I would like you to propose a topic that you would like to explore in some detail over the course of the semester on your personal blog.  Creating the blog can come later, but if you have that provide the URL in your post.  

As a new post, write a paragraph or brief description of what you plan to do. Feel free to propose a number of topics you might be interested in pursuing.  We can offer some suggestions.  Come up with an idea or two by next class on Jan. 28.

Escape Fire

There are 11 sections to this video (see below).  I offer them to you as a table of contents to remind you of sections you viewed.  After you watch the video, please post your reflections on the video and its implication for healthcare in the U.S., both uplifting and hopeful, as well as the more disturbing aspects. Initially, I'd rather not ask specific questions, but may comment on your posts to probe further.

What do you think about where we can look for optimistic outcomes, and where is the problem more entrenched and harder to dig our way out?

Post your thoughts on your blog, as a new post here, or as comment to this post. Remember commenting on others is important, too. Video Sections:

1. Escape Fire
2. Primary Care
3. Good People Bad System
4. A National Dependency
5. The Dark Matter of Medicine
6. The American Way
7. An Entrenched System
8. Throwing a Different Pitch
9. Change Your Lifestyle
10. Seeking Escape Fires
11. One Company